Depression in older people is underdiagnosed.
Depression in older people is underdiagnosed.
复制标题
老年人的抑郁症未被充分诊断。
作者：
Charlotte Allan;Vyara Valkanova;Klaus P Ebmeier
老年抑郁症比痴呆症更常见，但诊断和治疗不足。重要的是要认识到患者可能并不总是以典型的方式表现出来，可能表明抑郁的特征包括焦虑、对躯体症状的关注和功能的改变。只要症状普遍存在并且持续持续超过两周，可理解的触发因素和原因的存在不应阻止全科医生提供治疗。与年龄相关的残疾和身体健康的变化是老年人抑郁的主要危险因素。血管疾病，包括中风、心肌梗死和糖尿病，会通过对大脑的直接影响和心理影响增加患抑郁症的风险。同样，痴呆症是抑郁症的危险因素。孤独和失去重要角色等心理因素，以及与退休、丧亲和独立性下降相关的社会因素也可能会增加风险。有抑郁症和焦虑症病史的患者在以后的生活中患抑郁症的风险会增加。评估和诊断很大程度上基于仔细的病史。这应该集中于引出抑郁症的当前特征，这些特征已经存在至少两周，并且与功能的显着变化相关。重要的是要排除器质性疾病，包括贫血、维生素 B12 和叶酸缺乏，以及可能模仿抑郁症症状的甲状腺功能减退症。在以下情况下需要转诊至专业心理健康服务：诊断困难、对治疗反应不佳、精神病症状、明显的精神共病或自我忽视或自杀的风险。
Depression is more common in old age than dementia yet is underdiagnosed and undertreated. It is important to recognise that patients may not always present in a typical way, features that may indicate depression include anxiety, a preoccupation with somatic symptoms, and a change in function. The presence of understandable triggers and causes should not deter GPs from offering treatment, as long as symptoms are pervasive and continuously persist beyond two weeks. Age-related disabilities and changes to physical health are major risk factors for depression in older people. Vascular diseases, including stroke, MI and diabetes increase the risk of depression, both through direct effects on the brain and the psychological effects. Likewise, dementia is a risk factor for depression. Psychological factors such as loneliness and loss of a valued role, as well as social factors related to retirement, bereavement and reduced independence may also increase the risk. Patients with a previous history of depression and anxiety disorders are at increased risk of depression in later life. Assessment and diagnosis are largely based on a careful history. This should focus on eliciting current features of depression, which have been present for at least two weeks, and are associated with a significant change in function. It is important to exclude organic disorders including anaemia, B12 and folate deficiency, and hypothyroidism that may mimic symptoms of depressive disorder. Referral to specialist mental health services is indicated in the following cases: diagnostic difficulty, poor response to treatment, psychotic symptoms, significant psychiatric comorbidity or a risk of self-neglect or suicide.